Antithrombin III supplementation during orthotopic liver transplantation in cirrhotic patients: A randomized trial

Baudo, F.; DeGasperi, Andrea; Decataldo, Francesco; Caimi, Teresa Maria; Cattaneo, Daniele; Redaelli, R; Pannacciulli, E; Corti, A; Mazza, E.; Belli, Luca

doi:10.1016/0049-3848(92)90099-v

Cited by 27 publications

(9 citation statements)

References 15 publications

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“…On activation of the fibrinolytic cascade, plasmin catalyzes fibrin to FDP, increasing FDP levels. The natural anticoagulant, AT III, regulates the removal of thrombi from the vascular system [11]. The purpose of this study was to evaluate whether ulinastatin affected perioperative blood loss and blood transfusion requirements in patients undergoing major orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

The effect of ulinastatin on hemostasis in major orthopedic surgery

Lee

Chon

et al. 2010

Korean J Anesthesiol

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BackgroundUlinastatin, a urinary trypsin inhibitor, is widely used to treat acute systemic inflammatory disorders. However, the effects of ulinastatin, especially on the potential for hemostasis, have not been fully elucidated. This study examined whether ulinastatin had any beneficial effects on blood loss and blood transfusion requirements in patients undergoing major orthopedic surgery.MethodsEighty patients, aged 18 to 75 years, scheduled for major orthopedic surgery were enrolled in this study and were divided into the ulinastatin (n = 40) and control (n = 40) groups. Following the induction of general anesthesia, and immediately before the surgical incision, the patients in the ulinastatin group were given 5,000 units/kg of ulinastatin, which were mixed in 100 ml normal saline intravenously over 30 min, while those in the control group received the same volume of normal saline. The amounts of blood loss, infused fluid, and transfused blood products were measured throughout the study period. Blood samples for coagulation parameters were obtained before inducing anesthesia (T1), at the end of surgery (T2), and 12 h after surgery (T3).ResultsThe amounts of blood loss and infused fluid during surgery were not significantly different between the two groups. However, 12 h postoperative blood loss was significantly less in the ulinastatin group than in the control group (255.0 ± 133.2 ml VS. 395.4 ± 338.4 ml, P < 0.05).ConclusionsOur data suggest that a single infusion of ulinastatin in major orthopedic surgery is associated with decreased blood loss in the early postoperative period.

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Section: Introductionmentioning

confidence: 99%

The effect of ulinastatin on hemostasis in major orthopedic surgery

Lee

Chon

et al. 2010

Korean J Anesthesiol

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“…In human studies AT III activity was commonly increased to more than 80 %. However, there were no significant beneficial effects concerning attenuation of DIC as reflected by laboratory markers, prevention of bleeding or clinical complications when AT III was given perioperatively in patients undergoing the Le Veen shunt operation, hepatic resection, or liver transplantation [9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Since AT III substitution decreases fibrinogen turnover [7,8], decreased AT III activity possibly contributes in an important way to the increased fibrinogen turnover in patients with liver cirrhosis [8]. Therefore, AT III substitution may prevent the perioperative progression of low-grade to overt DIC [9][10][11][12][13]. AT III-substitution has also been recommended prior to procoagulant coagulation factor substitution Table 1 Biometrical data, Child classification [11], and diagnoses of 24 patients with chronic end-stage liver cirrhosis (median and range) [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, AT III substitution may prevent the perioperative progression of low-grade to overt DIC [9][10][11][12][13]. AT III-substitution has also been recommended prior to procoagulant coagulation factor substitution Table 1 Biometrical data, Child classification [11], and diagnoses of 24 patients with chronic end-stage liver cirrhosis (median and range) [9][10][11][12][13]. We, therefore, tested the hypothesis that an increase in AT III-activity to supranormal (175 %) activity decreases systemic procoagulant turnover in patients with endstage liver disease better than substitution to 100 % activity.…”

Section: Introductionmentioning

confidence: 99%

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The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease

1997

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Despite thrombin inhibition by AT III in patients with end-stage chronic liver disease, systemic procoagulant turnover was not significantly decreased 60 min after AT III application even to supranormal activities. Replenishment of the inhibitory antithrombin III pool, decreased in chronic liver disease, should not be expected to slow down the baseline consumptive component of the haemostatic disorder in this patient group.

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“…Results of prospective, randomized controlled studies with a small number of patients are inconclusive [33,40,41]. Although antithrombin III concentrates have been used intraoperatively, their indications in the orthotopic liver transplantation setting are not clear.…”

Section: During Liver Transplantationmentioning

confidence: 99%

Haemostatic disorders during liver transplantation

et al. 2001

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Profound and complex coagulation disorders are encountered during liver transplantation. They include preoperative coagulation disorders related to the liver disease and haemostatic changes related to the procedure itself. They commonly lead to increased intraoperative bleeding, especially due to increased fibrinolysis, the contribution of which can be demonstrated by the relative efficacy of antifibrinolytics. Given the multifactorial nature of bleeding in liver transplantation, preoperative coagulation tests cannot predict blood loss even if some statistical relationship is occasionally found. Preoperative correction of coagulation defects has not been shown to be effective in reducing intraoperative bleeding. Throughout the procedure, a rapid and sensitive method for monitoring coagulation is necessary in order to guide the rational use of blood components and pharmacological agents. The usefulness of such a method to assist management of blood loss or blood component requirements is poorly documented and controversial.

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Antithrombin III supplementation during orthotopic liver transplantation in cirrhotic patients: A randomized trial

Cited by 27 publications

References 15 publications

The effect of ulinastatin on hemostasis in major orthopedic surgery

The effect of ulinastatin on hemostasis in major orthopedic surgery

The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease

Haemostatic disorders during liver transplantation

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